Bursitis is the general term used to describe inflammation of any bursae. The bursae are the cavitary structures lined with synovial tissue that cushion and assist during the motion of joints and muscles. Bursitis is usually accompanied by tenderness; however, swelling and redness may also be present. Pes anserine bursitis is a clinical entity associated with pain at the medial knee and upper tibial region. The term “pes anserine” comes from the Latin referring to “goose’s foot,” which the tendinous structures of the semitendinosus, gracilis, and sartorius muscles are said to resemble as they join to insert at the medial knee. The pes anserine bursa is sandwiched between the proximal medial tibia and the insertion point of the three tendons.[1] A more generic term, pes anserine pain syndrome, has been applied to refer to medial knee pain, which may or may not include inflammation of the bursa sac. This article focuses on the clinical entity of pes anserine bursitis, unless otherwise specifically stated.

Bursitis is the swelling or inflammation of a synovium-lined sac-like structure called a bursa. These are found throughout the body near bony prominences and between bones, muscles, tendons, and ligaments.[1] They function to reduce friction between these structures. Inflammation of the bursa around large joints like the shoulder, knee, hip, and elbow may prompt patient visits to healthcare providers. There are four major bursae associated with the knee joint: suprapatellar, infrapatellar, pes anserine, and prepatellar. This article will focus on the prepatellar bursa and, specifically, prepatellar bursitis. This bursa is present between the patella and the overlying subcutaneous tissue. It represents the most commonly affected bursae of the knee and the second most commonly affected bursa overall, following the olecranon bursa. The location makes it a target during repetitive kneeling and has led to it being colloquially referred to as housemaids, carpet layers, and carpenters knee.

Stress injuries represent a spectrum of injuries ranging from periostitis, caused by inflammation of the periosteum, to a complete stress fracture that includes a full cortical break. They are relatively common overuse injuries in athletes that are caused by repetitive submaximal loading on a bone over time. Stress injuries are often seen in running and jumping athletes and are associated with increased volume or intensity of training workload. Most commonly, they are found in the lower extremities and are specific to the sport in which the athlete participates. Upper extremity stress injuries are much less common than lower extremity stress injuries, but when they do occur, they are most commonly seen in the ulna. Similar to the lower extremity injuries, upper extremity stress injuries are the result of overuse and fatigue. Rib stress fractures are an uncommon site of stress injuries. First rib fractures are the most common, and these are seen in pitchers, basketball players, weightlifters, and ballet dancers. Stress fractures in ribs 4 through 9 are seen in competitive rowers, and posteromedial rib stress fractures can be seen in golfers. Stress fractures of the pelvis can be vague clinically and mimic other causes of groin and hip pain, for example, adductor strain, osteitis pubis, or sacroiliitis. The most common location is the ischiopubic ramus and sacrum. These injuries are seen most commonly in runners. Femoral neck stress fractures make up approximately 11% of stress injuries in athletes. The patient complains of hip or groin pain which is worse with weight bearing and range of motion especially internal rotation. There are 2 types of femoral neck stress fractures: tension-type (or distraction) fractures and compression-type fractures. Tension-type femoral neck stress fractures involve the superior-lateral aspect of the neck and are at highest risk for complete fracture; thus, these should be detected early. Compression-type fractures are seen in younger athletes and involve the inferior-medial femoral neck. A trial of non-surgical management can be attempted for patients without a visible fracture line on radiographs in compression type injuries. This injury is common in runners. Stress fractures of the femoral shaft are well documented in the literature, and in one study among military recruits, they represented 22.5% of all stress fractures. Patients typically complain of poorly localized, insidious leg pain often mistaken for muscle injury. An exam is often nonfocal, although the “fulcrum test” test can be used by providers to localize the affected pain and suggest the diagnosis. If there is no evidence of a cortical break on imaging, a non-surgical approach can be attempted. The patella is a rare location for a stress fracture and can be oriented either transverse or vertical. Transverse fractures are at higher risk for displacement and immobilization is recommended. Tibial stress injuries are the most common location of stress reactions and fractures. Medial tibial stress syndrome (MTSS), also known as shin splints or tibial periostitis, can be difficult to distinguish from medial tibial stress fractures. Typically, the patient will be tender over the medial posterior edge of the tibia often made worse with a motor exam. Stress injuries will present with pain during activities of daily living, while MTSS is generally limited to exertional activity. Anterior cortex tibial stress fractures are less common than the posteromedial ones and are found in jumping and leaping athletes. These patients may have the “dreaded black line” on x-ray. They are at a greater risk of nonunion and full cortical break and require aggressive conservative therapy. If that fails, surgical management such as an intramedullary rod or flexible plate is indicated. Stress fractures of the medial tibial plateau are uncommon but can be confused for meniscus injury or pes anserine bursitis, and thus, a high index of suspicion is needed. Fibular stress fractures are common and most commonly located in the lower third of the fibula, proximal to the tibiofibular ligament. Patients will have reproducible pain on palpation of the affected bone. Medial malleolus stress fractures are uncommon. Running and jumping athletes can develop vertical stress fractures at the junction of the medial malleolus and tibial plafond. If full cortical disruption is identified, surgical fixation is typically indicated. Calcaneal stress fractures present as localized tenderness over the heel of the calcaneus posterior to the talus. Patients will have a positive squeeze test. Stress fractures can develop in the navicular, medial cuneiform, and lateral process of the talus. Navicular stress fractures are difficult to diagnose early on and are at high risk of nonunion due to poor vascular flow, primarily in the middle third. These are common in basketball players and runners. They are usually tender on the navicular bone. Metatarsal stress fractures account for 9% of all stress fractures in athletes. The second and third metatarsals are most commonly affected and are usually in the neck or distal shaft. They will be point tender with localized swelling over the affected bone. Dancers fracture is a stress fracture at the base of the second metatarsal. Stress fractures distal to the tuberosity of the fifth metatarsal are termed Jones fractures but must be distinguished from an acute Jones fracture. Sesamoid stress injuries of the great toe present as gradual unilateral plantar pain with the medial (tibial) sesamoid most frequently affected. Direct tenderness or pain with passive extension of the toe aid in diagnosis.

First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) have a higher risk for the development of RA. In the stages prior to the development of arthritis, nonspecific musculoskeletal (MSK) manifestations may occur. The aim of the study is to describe the frequency of rheumatic regional pain syndromes (RRPS) in FDR of RA patients. A cross-sectional study was carried out from July 2016 to September 2018. Parents, offspring, and siblings of RA patients completed the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire. Rheumatoid factor (RF) IgG, IgM, and IgA; anticitrullinated peptide antibodies (ACPAs); C-reactive protein (CRP); and erythrocyte sedimentation rate (ESR) were determined. All subjects with a positive COPCORD (defined by the presence of musculoskeletal pain) were evaluated and classified. Three hundred thirty-five FDRs participated, 75.8% were female, mean age of 44.15 years; 138 (41.2%) were diagnosed with at least one RRPS; 72 (21.5%) had rotator cuff tendinitis, 51 (15.2%) pes anserine bursitis, and 39 (11.6) lateral epicondylitis; RA was diagnosed in 24 (7.16%) subjects, undifferentiated arthritis (UA) in 30 (8.9%) and inflammatory arthralgia (AI) in 104 (31%). We found anti-CCP positivity in 6.8%, RF IgA in 22.3%, RF IgM in 48.6%, and RF IgG in 8.9%. The presence of RRPS was higher in this RA-FDR group compared to general population. Clinical evaluation of this risk group should include screening for RRPS.

Pes anserinus pain syndrome is a common, clinically defined condition that is characterized by pain around the medial knee and tenderness over the upper medial tibia. The anserine bursa could be the site of proliferative and inflammatory conditions due to knee osteoarthritis, leading to pain and fluid retention. However, rupture of the pes anserinus is rare. Herein, we present a case of rupture of the pes anserine bursa in a patient with pes anserine pain syndrome and osteoarthritis. Physicians should consider rupture of the pes anserine bursa as a differential diagnosis of acute unilateral lower leg swelling. J. Med. Invest. 66 : 211-212, February, 2019.

Physical therapy (PT) modalities are a diverse group of treatments for musculoskeletal pain. Iontophoresis, phonophoresis, kinesiology taping, laser therapy, and myofascial release are some of the most commonly used and are best considered as adjuncts to exercise. Each modality is relatively safe, but none is supported by high-quality evidence in the management of most musculoskeletal conditions. Individual patient response to such modalities is variable. Neither iontophoresis nor phonophoresis has been shown to have greater benefits for neck or back pain than supervised PT. However, use of phonophoresis has been shown to result in a small improvement when added to therapeutic exercise. Kinesiology taping improves symptoms for patients with plantar fascia pain, pes anserine bursitis, and low back pain (LBP). Laser therapy has shown small benefit in chronic LBP and shoulder disorders including adhesive capsulitis, calcific tendinitis and rotator cuff tendinopathies. Myofascial release, has been found to improve symptoms of neck pain. These modalities should never replace active PT, but their use should not be discouraged as part of a comprehensive program. A concern is cost because many health insurance companies consider these therapies to be medically unnecessary or experimental.

Soft tissue musculoskeletal pain disorders are common in the primary care setting. Early recognition and diagnosis of these syndromes minimizes patient pain and disability. This article gives a brief overview of the most common soft tissue musculoskeletal pain syndromes. The authors used a regional approach to organize the material, as providers will encounter these syndromes with complaints of pain referring to an anatomic location. The covered disorders include myofascial pain syndrome, rotator cuff tendinopathy, bicipital tendinopathy, subacromial bursitis, olecranon bursitis, epicondylitis, De Quervain disease, trigger finger, trochanteric bursitis, knee bursitis, pes anserine bursitis, Baker cyst, plantar fasciitis, and Achilles tendinopathy.

Pes anserine bursitis (PAB) is an inflammation of the bursa located between the medial aspect of the tibia and the hamstring muscles. It is common in patients with degenerative or inflammatory knee arthritis, usually has a self-limiting course and tends to respond well to conservative treatment. However, painful PAB directly following total knee replacement surgery is rare. We report two such cases who were diagnosed via ultrasonography at the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, in 2015. Both patients were treated locally with triamcinolone acetonide under ultrasound guidance and responded well to treatment.

Pes anserine (PA) bursitis is an inflammatory condition of the medial knee. The PA bursa becomes more painful when infected, damaged, or irritated. Although various treatment options have been attempted to treat PA bursitis, optimal treatments are still debated. This study aims to investigate the effect of polydeoxyribonucleotide (PDRN) injection on reducing pain and inflammation in a patient presenting with PA bursitis.

[Purpose] The aims of this study were twofold. The first was to compare the functional capacity and pain of patients with knee osteoarthritis (KOA), with or without pes anserine tendino-bursitis (PATB). The second is to compare the efficacy of two treatment methods (physical therapy and corticosteroid injection) for patients with PATB. [Subjects and Methods] Sixty patient with KOA and PATB (Group 1) and 57 patients with KOA but without PATB (Group 2) were enrolled in the study. The patients' visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores and three-meter timed-up and go scores were measured. The PATB group was randomly divided into two groups (Group A and B). Physical therapy (PT) modalities were applied to the first group (Group A), and the second group (Group B) received corticosteroid injections to the pes anserine area. Eight weeks later, patients' parameters were measured again. [Results] Initial WOMAC scores and timed up-and-go times were significantly higher in Group 1 than in Group 2. Both treatments resulted in significant improvements in all measured parameters, but no significant difference was detected between Group A and B. [Conclusion] Patients with PATB tend to have more severe pain, more altered functionality, and greater disability than those with KOA but without PATB. Both corticosteroid injection and PT are effective methods of treatment for PATB. Injection therapy can be considered an effective, inexpensive and fast therapeutic method.

This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98-6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03-22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37-12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19-3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36-1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60-2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59-1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52-1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50-1.01); anserine syndrome: 0.64 % (95 % CI: 0.44-0.92); inferior heel pain: 0.61 % (95 % CI: 0.42-0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25-0.64); de Quervain's tendinopathy: 0.45 % (95 % CI: 0.29-0.70); trigger finger: 0.42 % (95 % CI: 0.27-0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16-0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05-0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02-0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in overall RRPS prevalence between the remaining pairs of indigenous groups. Syndrome-specific prevalences were also different between groups. Our findings support the hypothesis that overall RRPS prevalence and syndrome-specific prevalences are modulated by population-specific factors.

The aim of this prospective study was to determine the prevalence of pes anserine bursitis (PAB) in patients with osteoarthritis. A total of 85 patients with primary knee osteoarthritis diagnosed according to the American College of Rheumatology (ACR) criteria were included in the study. The patients were divided into four groups using the Kellgren-Lawrence staging system. The knee X-rays evaluated according to this system indicated that 15.6% of patients were grade 1, 34.1% grade 2, 37.1% grade 3, and 13.5% grade 4. Ultrasonography (USG) was performed on both knees by a radiologist experienced in musculoskeletal system ultrasonography and unaware of the patients' physical examination or direct X-ray findings. The presence of PAB, longest diameter of bursitis, and area of bursitis were recorded. The average age of the 11 male and 74 female patients included in the study was 58.9 ± 9.0 years. A total of 170 knees of 85 patients were examined. The incidence of bursitis was significantly higher in females (p = 0.026). The incidence of bursitis on ultrasound was 20% (34/170). There was a statistical difference between the grades for bursitis incidence (p = 0.004). There was a significant positive correlation between both the longest length (p = 0.015, r = 0.187) and area (p = 0.003, r = 0.231) of PAB with osteoarthritis grade. The mean age of bursitis patients was higher than that of those without the condition (p = 0.038). In addition, the osteoarthritis (OA) grade and bursitis prevalence increased as the patients' age increased, and these increases were statistically significant (p < 0.001). PAB is easily evaluated with ultrasonography. Pes anserine bursitis was observed in one out of every five symptomatic OA patients and was more common in female patients and with advanced age. A positive correlation was found between OA grade and PAB size and area.

The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, p < 0.01). In multivariate analyses, DM patients had 2.47 (95 % CI 1.05, 5.84) the odds of having bursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain's tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (p < 0.05). Among DM patients, multivariate analyses showed that those with bursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease.

The patient was a 25-year-old man who was serving in the military. He was referred to a physical therapist for a progressively worsening painful snapping sensation in the posteromedial left knee region. Prior magnetic resonance imaging for the left knee was interpreted as normal, except for a mild fluid signal about the left pes anserine bursa. The patient was diagnosed with snapping pes anserine syndrome. However, despite 6 weeks of physical therapist intervention, the patient did not improve. A dynamic real-time ultrasound examination was then ordered, which demonstrated that the pes anserine tendons changed position as the knee moved from flexion to extension, sliding across a heterogeneous rounded mass in the posteromedial knee.